Psychotherapy Notes

What Is Psychotherapy?

Psychotherapy is defined as a treatment for emotional problems, involving a trained person establishing a professional relationship with a patient. The goals are to remove, modify, or retard existing symptoms, mediate disturbed behavior patterns, and promote positive personality growth and development.

Elaboration of the Definition

  • Psychotherapy as Treatment: It is fundamentally a form of treatment, even when described using terms like "reeducation" or "guidance."
  • Problems of an Emotional Nature: These problems are diverse and affect various aspects of a person's life, including psychic, somatic, interpersonal, and community life. It's difficult to separate social and interpersonal issues from psychic and psychosomatic disorders.
  • Role of a Trained Person: Individuals often seek help from friends or figures of authority, but emotional problems require skilled intervention acquired through extensive training and experience. Untrained attempts to handle emotional turmoil can be disastrous.
  • Professional Relationship: The therapeutic relationship is carefully planned and nurtured by the therapist, differing from typical social interactions. It maintains a professional level aimed at specific therapeutic goals.
  • "Patient" Designation: The person receiving treatment is referred to as a "patient."
  • Removing Symptoms: A primary goal is to alleviate the patient's suffering and the limitations caused by their symptoms.
  • Modifying Symptoms: Complete relief may not always be possible due to factors like inadequate motivation, ego strength, or limitations in time and finances. In such cases, therapy aims to modify rather than completely cure symptoms.
  • Retarding Symptoms: In severe emotional illnesses like fulminating schizophrenic disorders, psychotherapy may only slow down the inevitable deterioration, but this palliative effect can still be valuable in helping the patient maintain contact with reality.
  • Mediating Disturbed Behavior Patterns: Psychotherapy's scope has expanded to address emotional factors in occupational, educational, marital, interpersonal, and social problems. The focus has shifted from just symptom relief to correcting disturbed interpersonal patterns and relationships, acknowledging the involvement of character structure in emotional illnesses.
  • Promoting Positive Personality Growth and Development: Psychotherapy also serves as a means for personality maturation, addressing immaturity in "normal" individuals and characterologic difficulties that were once considered untreatable. It seeks to resolve blocks in psychosocial development, enabling individuals to achieve greater self-fulfillment, adopt more productive attitudes, and foster more rewarding relationships.

Other Definitions of Psychotherapy

While the comprehensive definition provided is advantageous, other definitions exist with more limited scopes. Psychoanalysts, for example, may distinguish psychoanalysis (dealing with unconscious material) from psychotherapy (addressing conscious material). Some Freudian psychoanalysts classify only Freudian psychoanalysis as "psychoanalysis," relegating other approaches to "psychotherapy." Some therapists consider all psychotherapy as "psychoanalytic psychotherapy," while others view it as solely composed of supportive and reeducative techniques.

Common Agreement

Despite varying views, most definitions agree that psychotherapy is an approach to emotional problems but disagree on techniques, processes, goals, and personnel.

Examples of Definitions:
  1. Psychotherapy is the use of psychological measures in the treatment of sick people.
  2. Psychotherapy endeavors to alter the behavior and change the attitudes of a maladjusted person toward a more constructive outcome.
  3. Psychotherapy alludes to the entire collection of approaches attempting to influence or assist a patient toward more desirable ways of thinking, feeling, and behaving.
  4. Psychotherapy is meant the use of measures which it is believed will act upon the patient's mind and thereby promote his mental health and aid his adjustment to the particular problems which have disturbed his happiness or adaptation.
  5. Psychotherapy is a form of treatment in psychiatry in which the psychiatrist, by his scientific thinking and understanding, attempts to change the thinking and feeling of people who are suffering from distorted mental or emotional processes.

Varieties of Psychotherapy

Seeking treatment for emotional problems can be perplexing due to the multitude of available options and opinions.

Sources of Advice

  • Family Physician: May suggest slowing down and relaxing, along with medications like tonics, vitamins, endocrine substances, benzedrine, sedatives, or placebos.
  • Minister: May advise increased devotion to religion and reliance on God.
  • Lawyer: May recommend a long vacation to escape business pressures.
  • Friends: May suggest leaving a job, divorcing, finding a hobby, exploring Christian Science, seeing a chiropractor, or reading self-help books.

Professional Help Confusion

Professional help options can be equally confusing, especially in large cities with many therapy types.

  • Therapeutic Approaches:
    • Adolf Meyer's "common sense" method
    • Orthodox Freudian psychoanalysis
    • Deviant psychoanalytic schools (Adler, Jung, Stekel, Rank, Horney, Sullivan)
    • Hypnosis or narcosynthesis techniques
    • Short-term therapy (Alexander and French)
    • Psychiatric interviewing (Finesinger)
    • Non-directive therapy (Rogers)
    • Psychodrama (Moreno)
    • Inspirational group therapy
    • Orgone box therapy
    • Conditioned reflex therapy

Conflicting Claims and Data

It is difficult to navigate the various treatment methods for emotional illness due to exaggerated claims and criticisms. Statistical data on cure, improvement, and failure rates often show similar results across different methods. People seem to benefit from various therapies, including those with and without scientific approval.

Questions and Considerations

  • Why do some individuals fail to respond to intensive psychoanalysis but find relief with an untrained person?
  • Are there qualitative differences in improvement across different treatment forms?
  • Do specific problems respond better to particular treatment methods?
  • Are there differences in the permanency of results from different procedures?
  • Is there a "best" treatment for neurosis?
  • How much of recovery is due to spontaneous reparative elements, regardless of treatment?

Chart I: Varieties of Psychotherapy

The varieties of psychotherapy can be divided into two main groupings: supportive therapy and insight therapy. Insight therapy has two subgroups: (1) insight therapy with reeducative goals (reeducative therapy) and (2) insight therapy with reconstructive goals (reconstructive therapy).

Supportive Therapy
  • Objectives:
    • Strengthening of existing defenses.
    • Elaboration of new and better mechanisms to maintain control.
    • Restoration to an adaptive equilibrium.
  • Approaches:
    • Guidance, environmental manipulation
    • Externalization of interests
    • Reassurance, pressure and coercion, persuasion
    • Emotional catharsis and desensitization
    • Prestige suggestion, suggestive hypnosis
    • Muscular relaxation, hydrotherapy, drug therapy, shock and convulsive therapy
    • Inspirational group therapy
    • Music therapy.
Insight Therapy with Reeducative Goals
  • Objectives:
    • Insight into the more conscious conflicts, with deliberate efforts at readjustment, goal modification and the living up to existing creative potentialities.
  • Approaches:
    • "Relationship therapy"
    • "Attitude therapy"
    • Interview psychotherapy
    • Distributive analysis and synthesis (psychobiologic therapy)
    • Therapeutic counseling, casework therapy
    • Reconditioning, reeducative group therapy
    • Semantic therapy.
Insight Therapy with Reconstructive Goals
  • Objectives:
    • Insight into unconscious conflicts, with efforts to achieve extensive alterations of character structure.
    • Expansion of personality growth with development of new adaptive potentialities.
  • Approaches:
    • Freudian psychoanalysis
    • Non-Freudian psychoanalysis
    • Psychoanalytically oriented psychotherapy
    • (Adjunctive therapies: hypnoanalysis, narcotherapy, play therapy, art therapy, analytic group therapy)

Diversity and Divergences

The available psychotherapies in supportive, reeducative and reconstructive categories become more diverse as increasing numbers of professionals enter the psychotherapeutic field, introducing into it their unique technical modifications. Schools of psychotherapy have crystallized around the various approaches, each of which has its zealous disciples as well as its staunch critics. Each lays claim to multifarious successes and admits to some failures. Actually, radical divergencies in technique are more apparent than real, many distinctions vanishing as soon as semantic differences are resolved. However, some tangible differences exist, which will be examined in detail in the subsequent chapters.